YMCA of Snohomish County 2/6/2020

RN►® ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MM(DDIYYYY) ‘1'"*.- 8/29/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CURIAL Michelle Parker NAME: Leavitt Group Northwest PHONE (800)726-8771 FAX 1866)725-9168 No Fxtl: (A(C,No): PO Box 65770 ADDRESS:michelle-parker@leavitt.corn INSURER(S)AFFORDING COVERAGE NAIC B University Place WA 98464 INSURER A:Great American Insurance Company C16691 INSURED INSURERB:Philadelphia Insurance Compnay 23850 YMCA of Snohomish County INSURERC: Scott Washburn INSURER D: 2720 Rockefeller Ave INSURER E: Everett WA 98201 INSURERF: COVERAGES CERTIFICATE NUMBER:19-20 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR " AUIIL-SOUR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDfYYYY) (MMlDDITYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A - CLAIMS-MADE I X I OCCUR DAMAGE 10 RENTED 100,000 PREMISES(Ea occurrence). $ X PAC321858300 9/1/2019 9/1/2020 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENII AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY I I PRO • - JECT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: Sexual Abuse or Moleslaeon $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident) A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS CA11321858400 9/1/2019 9/1/2020 BODILY INJURY(Per aCrident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS $ (Per accident) X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A ,^ EXCESS LIAR CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ 0 i1NB321858500 9/1/2019 9/1/2020 $ WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY YIN I STATUTE 1 x I ERH ANY PROPRIETOR/PARTNER/EXECUTIVE p7 " A OFFICER/MEMBER EXCLUDED? I N(A E.L.EACH ACCIDENT S 1,000,000 (Mandatory in NH) 1 YAC321858300 9/1/2019 9/1/2020 E L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION DF OPERATIONS below WA Stop Gap E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Crime Liability PBSD1476076 4/1/2019 9/1/2020 Pm Claim Deduct 2,500 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) RE: City of Everett Community Development Block Grant. The City ofEverett, its officers, employees and agents is additional insured as per terms and conditions of the policy per attached form CG2026 04-13. CERTIFICATE HOLDER CANCELLATION JSworen@ymca-snoco.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Everett THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Office of Community, ACCORDANCE WITH THE POLICY PROVISIONS. Planning 6 Economic Development Attn: Kembra Landry AUTHORIZED REPRESENTATIVE 2930 Westmore Avenue, Ste 8Atil 0 Everett, WA 98201 Jeff Olsen/MIPARK IA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1N5025 201401)